Do I need Surgery?
Many people who injure themselves ultimately ask the question: do I need surgery? Surgery may not help you gain additional benefit to your recovery. With the risks involved with surgery it is important to know what studies show when it comes to having surgery. With the information below you will be able to make a better decision when deciding if surgery is right for you. Seeing a physical therapist will also help you determine if non-surgical options can get you to where you need to be without surgery.
Red Flags (Scary Things)
There are some reasons to go the see a surgeon. Broken bones, rapid loss of strength in your arms or legs, pain that does not change by position, abdominal/chest pain, and diagnosed cancer are all reasons to see a surgeon to get their advice. Despite popular belief most joint pain, back pain, muscle and ligament injuries do not need surgery.
Normal Findings (We All Have Them)
There are many things that are considered normal findings on MRIs and X-rays such as disk herniation, rotator cuff tears, meniscal tears, degenerative joint disease, and labral tears. This means that people who do not have symptoms typically have some or all of these “conditions” when you look at the area with an MRI. In other words, some people who do not have symptoms would likely have some of these things show up on their MRI. MRI findings are not a direct reason to have surgery in the above cases. Many of these structural changes were likely there before you had pain and are findings that have nothing to do with your symptoms. The bad news is that surgery may not have any effect on your pain or symptoms. The good news is that you can improve your symptoms without surgery.
Disc Herniation is very common and in studies they are found in over 50% of people who do not have pain. They are normal changes that occur naturally with time. If you do not have rapid loss of strength such as foot drop, or pain that does not change with your body position, the disk herniation may not need addressed surgically. The good news is that the body can recover from disc herniation without surgery.
Rotator Cuff Tears
Rotator cuff tears are also common, especially as we get older. There is a 22.1% chance someone without pain will have a rotator cuff tear. As we age partial tears become complete tears but this does not mean you will have shoulder pain. A study found that you are twice as likely to have a rotator cuff tear if you do not have pain than if you do. Physical therapy can help you regain motion, improve strength, and get you back to the things you want to do even after a diagnosis of rotator cuff tear.
Knee Menisical Tears
Meniscal tears are also very common. In a study on people over 50, 61% of the people who had a tear found on MRI did not have pain, stiffness, or achiness in the last month. This means that more people who had a meniscal tear did not have have pain than those who did. This is a very common finding and may not have anything to do with your knee pain. Meniscal tears are one of the most common findings on knee MRIs and physical therapy is very effective in helping those with knee pain.
Degenerative Joint Disease
Degenerative joint disease (DJD), should be seen as wrinkles on the inside. You will not ever hear someone calling wrinkles on our faces degenerative face disease, however. This is because we recognize it as a normal sign of aging. This is the same for DJD. Studies have found that the same percentage of people with and without knee pain have DJD. People who are more active have less knee pain, but have more degeneration in their knees. Degeneration is a gradual change, and staying active and seeing a physical therapist can help reduce your pain. The earlier you see your physical therapist for your symptoms, the better. It is much more difficult to reduce knee or joint pain when it has gone on for months or years. It is not impossible to recover, and if you have degenerative joint disease surgery isn’t the only option. Try non-surgical options first.
Shoulder Labral Tears
Labral tears are also common findings. Just as with meniscal tears, people who use their shoulder often tend to have labral tears in their shoulder. It may simply be a sign of use. In studies looking at people without shoulder pain, 55-72% of their MRIs were read as having a labral tear. You can recovery from your shoulder pain, especially if the injury was not due to impact. Shoulders dislocated during a fall have only a 16% chance of recovering without surgery to prevent future dislocations. If you have had one or more dislocations without fall or injury, you likely will recover and return to your activities without surgery. A thorough history is important, and a physical therapist can help determine which route is best for you.
Spinal Fusion (Lobotomy of our time)
In an article in SPINE, the authors found that lumbar fusion for disc degeneration, herniated discs, and/or radiculopathy, for those going through workers compensation saw more disability, increased opioid use, more lost time at work, and poor ability to return to work (summary found here). As mentioned above these are common findings, and more and more evidence is pointing to our inability to determine the area of the symptoms. A one size fits all treatment is not the final answer for a condition as complex as back pain.
Many people feel surgery is their last resort and they will try anything to help their pain. As mentioned, above disc changes are normal in people without pain. MRI findings are not a good reason for spine surgery. Research is finding physical therapy is effective for back pain regardless of length of symptoms. Pain has multiple factors and gaining a better understanding of why you continue to feel pain, a gradual graded change in activity with a physical therapist, and psychological consult can provide much better outcomes than the effect of spinal fusion.
Knee Surgery (It Needs To Look Pretty)
Surgeries for knee pain are the most prevalent elective surgeries in the United States. Knee replacement, ACL reconstruction, and meniscal tears have all found to be lacking in their effects and long term benefits. The quick fix is often what people are looking for, but surgery is not a quick fix. Recovery times range from 6 weeks to years for the surgeries mentioned, and you may end up having more surgery later.
Knee Replacement Surgery
Knee replacement has the benefit in decreasing pain in about 80% of people in the long term. Research shows that activity levels do not change, and knowing the long term effects is important. Many people who end up with knee replacements, however, have either “failed” physical therapy or never went. Decreased pain and increased activity level come from hands-on treatment, education on why you hurt, and increasing your activity level. Worst outcome of quality physical therapy where you are the center of attention is that you have surgery at a later time and are able to do more after. Three months of guided exercise and activity can prevent surgery. Surgery comes with risks such as blood clots, nerve injury, fracture, and to top it off 10-20% of people still have moderate to severe pain after the replacement.
ACL Reconstruction Surgery
ACL reconstruction in the United States is seen as the only option following an ACL tear. This, however, is not the case. A study showed 61% of people who had their reconstruction delayed decided to never have their surgery. Amazingly, the same percentage of people returned to their goal level of function regardless of whether they had the surgery or not.. With a 61% chance to return to your level of activity faster (3 months vs 12 months) it is often worth the effort. Not to mention that more than 14% of people eventually tear an ACL at a later time. Research has shown that people who have certain criteria can function without surgery. A physical therapist can help you determine if you meet the criteria, or if you should consult a surgeon.
Meniscal Tear Surgery
Surgery for meniscal tears has specific criteria that lead a surgeon to operate. Namely, recent events contributing to onset, loss of knee motion compared to the other side, and locking of the knee. Research on degenerative tears has shown that if someone does not have any of the above, they will not likely benefit from the surgery. The study looked at people who had tears and they either cut the tear out or left it. After a year they all had the same outcome. Removing the meniscus is not needed for recovery from most meniscal tears.
Knees joints carry our full weight and need to move to get nourishment. Motion is lotion for the knee joint and it needs to move to recover and get nutrition. Without movement many people end up having surgery where they did not need it. Daily changes and a brief stint in physical therapy may be all you need to prevent the need for one or more surgeries.
In Support of Surgery (The Devils In The research)
Some people do need surgery, and surgery, especially emergency surgery, saves lives and helps many people. Elective surgeries are pushed to market before there is testing showing their benefit. High quality physical therapy can help you determine if surgery is needed. With our directed attention and time you have the ability to avoid having surgery.
At Ascend Orthopaedics we provide one-on-one care that allows us to provide the best chance for you to avoid surgery, return to the things you want to do, and ultimately avoid making decisions that may provide no benefit. If you do decide to have surgery ask your surgeon if they can provide the research to you that shows that it will benefit you, ask about any major complications, and ask for the research on what happens to people like you who don’t have the surgery. To make the right decision for your body, being informed is key.
If you desire more information please schedule with us today.